License Verification

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DANIELLE NICOLE JIVIDEN

License Number: PA9115006

Data As Of 4/25/2025

Profession
Physician Assistant
License
PA9115006
License Status
CLEAR/Active
Qualifications
Dispensing Practitioner
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
09/22/2021
Address of Record
13681 Doctors Way
FT MYERS, FL 33912
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No

No secondary locations found.


Name Relationship Profession License Effective Date
FEIOCK, BRIAN DAVID M D Supervising Prescribing Practitioner Medical Doctor 61261 04/24/2024
HADDAD, ROBERT M Supervising Dispensing Practitioner Medical Doctor 106006 01/01/2022
HADDAD, ROBERT M Supervising Prescribing Practitioner Medical Doctor 106006 01/01/2022
HAZAN, TAL B Supervising Prescribing Practitioner Medical Doctor 107950 04/24/2024
KOKA, RAMESH Supervising Prescribing Practitioner Medical Doctor 97934 04/24/2024
PEREZ BARRIOS, JULIAN ANDRES Supervising Prescribing Practitioner Medical Doctor 108842 04/24/2024
RAJU, SRINIVAS MUDUNDI Supervising Prescribing Practitioner Medical Doctor 88683 04/12/2024

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Name Relationship Profession License Effective Date

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Name Relationship Profession License Effective Date

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No Continuing Education Hours Received from Approved Providers As Of 4/25/2025



* To find out more about Approved Providers, or ask a provider why the course you took is not yet listed, please visit our Continuing Education Providers page.


** Personal Development is limited to no more than 3 hours per renewal cycle. Any personal development hours in excess of this 3 hour maximum cannot be used for renewal and have been subtracted from the total available for renewal.


Please do not fax proof of Continuing Education hours to the Board Office until you have received your renewal notice in the mail.


For instructions on how to request a license certification of your Florida license to be sent to another state from the Florida Department of Health, please visit the License Certifications web page.